Results: Intraoperatively, multiple pigmented masses adherent to the nerve roots were partially removed preserving the fascicles. The patient's postoperative course was uneventful, motor function improved, and pain decreased. Histologic evaluation showed malignant melanoma. No primary lesion could be found on either dermatologic or ophthalmologic examination so that primary meningeal melanoma is the final diagnosis. Control MR imaging 4 weeks after the initial imaging demonstrated no significant progress of the residual lesions. A chemotherapy with temozolomide was initiated.

Conclusions: Primary malignant melanoma of the meninges is a rare entity posing diagnostic problems. It has not only to be differentiated from the common intradural extramedullary tumours but also from benign melanocytomas and pigmented schwannomas. Surgical intervention is justified to establish the diagnosis.